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目的探讨体外受精与胚胎移植(IVF-ET)超排卵(COH)周期中抗苗勒管激素(AMH)联合三维超声卵巢血管成像预测多囊卵巢综合征(PCOS)的反应性的价值。方法选择2013年8月至2014年9月行黄体中期长方案超排卵PCOS患者40例为研究对象,根据COH后E2水平和获卵数分为2组:卵巢正常反应组(23例)和卵巢高反应组(15例)。比较两组的临床资料、IVF参数、AMH、三维超声指数并分析这些指标与卵巢反应的相关性。结果卵巢高反应组与正常反应组之间的血管指数(VI)、血流指数(FI)、血管血流指数(VFI)的差异无统计学意义(P>0.05);卵巢高反应组窦卵泡数、平均卵巢体积、D3天AMH浓度明显高于卵巢正常反应组,差异有统计学意义(P<0.05);logistic回归分析和ROC曲线分析显示:D3天AMH浓度、窦卵泡数可以预测卵巢的反应性(P<0.05);平均卵巢体积、血管指数(VI)、血流指数(FI)、血管血流指数(VFI)与卵巢的反应性无相关性(P>0.05)。结论 PCOS卵巢高反应患者的三维能量多普勒超声卵巢血流指数没有增加,不能预测卵巢反应性,而其窦卵泡数和AMH浓度明显增加,与卵巢的反应性相关,可以作为卵巢反应的预测指标。
Objective To investigate the value of anti-Mullerian hormone (AMH) combined with three-dimensional ultrasound and ovarian angiography in prediction of polycystic ovary syndrome (PCOS) reactivity during IVF-ET (COH) cycles. Methods From August 2013 to September 2014, 40 patients with long-term ovariectomized PCOS patients were divided into two groups according to E2 level and number of oocytes retrieved after COH: normal ovarian response group (23 cases) and ovary High response group (15 cases). The clinical data, IVF parameters, AMH, three-dimensional ultrasound index were compared between the two groups and the correlation between these indexes and ovarian response was analyzed. Results There was no significant difference in vascular index (VI), blood flow index (FI) and vascular permeability index (VFI) between ovarian hyperresponsiveness group and normal responders (P> 0.05) (P <0.05). Logistic regression analysis and ROC curve analysis showed that AMH concentration at day D3 and the number of antral follicles in the ovaries could predict ovarian (P <0.05). The average ovarian volume, vascular index (VI), blood flow index (FI) and vascular permeability index (VFI) had no correlation with ovarian reactivity (P> 0.05). Conclusions There is no increase in ovarian flow index in three-dimensional energy Doppler ultrasound in PCOS patients with ovarian hypersensitivity, which can not predict ovarian response, while the number of antral follicles and AMH concentration in PCOS patients is significantly increased, which is correlated with ovarian reactivity and can be used as a prediction of ovarian response index.